title: Risks and benefits of screening asymptomatic women for ovarian cancer: a systematic review and meta-analysis.
abstract: OBJECTIVE
  We performed a systematic review and meta-analysis to quantify risks and benefits of screening asymptomatic women for ovarian cancer.
  
  
  METHODS
  We searched MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL, without language restrictions, from January 1, 1979 to February 5, 2012. Eligible studies randomly assigned asymptomatic women to screening or usual care. Two reviewers independently screened studies for eligibility, extracted data using a standardized, piloted extraction form, and assessed bias and strength of inference for each outcome using the GRADE framework. Chance-corrected agreement was calculated at each step, and disagreements were resolved through consensus.
  
  
  RESULTS
  Ten randomized trials proved eligible. Screening did not reduce all-cause mortality (relative risk (RR)=1.0, 95% confidence interval (CI) 0.96-1.06), ovarian cancer specific mortality (RR=1.08, 95% CI 0.84-1.38), or risk of diagnosis at an advanced stage (RR of diagnosis at FIGO stages III-IV=0.86, 95% CI 0.68-1.11). Transvaginal ultrasound resulted in a mean of 38 surgeries per ovarian cancer detected (95% CI 15.7-178.1) while screening with CA-125 led to 4 surgeries per ovarian cancer detected (95% CI 2.7-4.5). Surgery was associated with severe complications in 6% of women (95% CI 1%-11%). Quality of life was not affected by screening; however, women with false-positive results had increased cancer-specific distress compared to those with normal results (odds ratio (OR)=2.22, 95% CI 1.23-3.99).
  
  
  CONCLUSIONS
  Screening asymptomatic women for ovarian cancer does not reduce mortality or diagnosis at an advanced stage and is associated with unnecessary surgery.
authors.affiliation: Division of Gynecologic Oncology, University of Toronto, Toronto, Canada. clare.reade@mail.utoronto.ca
authors.forename: Clare J
authors.initials: CJ
authors.lastname: Reade
authors.forename: John J
authors.initials: JJ
authors.lastname: Riva
authors.forename: Jason W
authors.initials: JW
authors.lastname: Busse
authors.forename: Charlie H
authors.initials: CH
authors.lastname: Goldsmith
authors.forename: Laurie
authors.initials: L
authors.lastname: Elit
mesh_terms: D058070:Asymptomatic Diseases; D018394:CA-125 Antigen / Q000097:blood; D016001:Confidence Intervals; D055088:Early Detection of Cancer; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality*; D011788:Quality of Life; D012306:Risk; D018570:Risk Assessment; D014463:Ultrasonography
chemical_list: D018394:CA-125 Antigen
keywords: CA-125; Harm; Ovarian cancer; Screening; Systematic review; Transvaginal ultrasound